Surgery 6th TCVS

Surgery 4th LE: TCVS ver.1 1.

8.

A 31 year old female with persistent cough, wheezing and occasional hemoptysis is found to have a right bronchial obstruction. This is most likely due to: Carcinoid tumor Hamartoma SVC sundrome Lymphoma Thymoma

a. b. c. d. e.

A 45 y/o patient comes in for hemoptysis about 5 times, each amounting to about 100 ml, still ongoing. The gdiagnostic exam of choice to localize the site of bleeding is Chest xray Chest CT scan Bronchography Fiberoptic bronchoscopy Rigid bronchoscopy

2. a. b. c. d. e.

The most common cause of such hemoptysis is PTB Lung cancer Lung abscess Bronchiectasis Bronchial carcinoid

a. b. c. d.

3.

A 67 year old asymptomatic smoker presents with a 2.6 cm mass with ill defined borders in the right upper lobe. He has a history of thyroidectomy for well- differentiated thyroid cancer 10 years ago. The most likely diagnosis is Metastatic cancer from the thyroid Primary lung cancer Metastasis from an unknown head and neck cancer Metastasis from a gi tract cancer Tb granuloma

10. Neoadjuvant chemotherapy for lung cancer is sometimes recommended to a. Alleviate the systemic effect of chemotherapy by spreading out the treatment intervals b. Reduce the extent of surgical resection c. Make the surgery more manageable if the tumor is big or bulky, and near vital Structures d. Reduce the total radiation dose needed e. To kill the tumor cells prior to surgical manipulation

a. b. c. d. e. 4.

a. b. c. d. e. 5.

a. b. c. d. e. 6. a. b. c. d. e. 7.

a. b. c. d. e.

9.

e.

A 27 year old diving instructor came in for mild chest pain and was found on chest xray to have 15% pneumothorax on the right lung. Definitive treatment would ideally consist of Observation and treatment with analgesics 100% oxygen inhalation with complete resorption of thepneumothorax Tube thoracostomy VATS Open thoracotomy An otherwise healthy patient consults for sudden difficulty in breathing and is found to have decreased breath sounds on the left and tracheal deviation to the right. He has a bp of 80/60 and rr of 34. He probably has Cardiac tamponade Traumatic asphyxia Massive left hemothorax Tension pneumothorax Severe bronchoconstriction Which of the following constitutes contraindication to surgery in lung CA? Ipsilateral hilar lymphadenopathy Pleural effusion 4cm tumor involving the hilum Chest wall involvement by the tumor Superior vena cava syndrome

a. b. c. d. e.

a

A 19 year old male presents with an anterior mediastinal mass found on routine chest xray. Which among these tests should you request for in the work up? A-feto protein CEA B-HCG CA-125 Cytokeratin

A patient with emphysematous bullae is a good candidate for surgery if he has Chronic symptoms, stable disease Multiple, one sided small bullae Concomitant tb lesion on the same lobe Single large bulla involving more than 1/3 of the hemithorax Poor pulmonary function ( target: improvement)

11. In a patient with suspected pleural mesothelomia which diagnostic procedure would you recommend? a. Thoracentesis with fluid cytology b. Percutaneous lung biopsy c. Mediastinoscopy d. VATS e. Thoracotomy and open biopsy 12. a. b. c. d. e.

Neglected empyema thoracis often results in Lung abscess Necrotizing pneumonia Empyema necessitates Trapped lung Mediastinitis

13. A 44 year old female presents with an anterior neck mass of 12 years duration but is otherwise asymptomatic. On work up the mass is seen to have a connection to a moderately large mediastinal mass. This is most likely a. Lymphoma b. Cervical goiter with mediastinal extension c. Benign thymoma with cervical involvement d. Mediastinal thyroid with cervical involvement e. Parathyroid adenoma with mediastinal involvement 14. An 18 year old student is brought in by his parents for a well circumscribed 1.5 cm mass lesion in the right upper lobe, he is otherwise asymptomatic. They are concerned because the family is up for immigration to Canada within the next 3 months. You would advise a. Observation with serial radiography/ imaging studies b. VATS, possible wedge resection c. Open thoracotomy, possible lobectomy d. Radiation trial e. Treat with anti tb for 6 months

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15. A 22 year old female is referred to you for ptosis, mild dysphagia and progressive weakness through the day of a few month’s duration. She is found to have an anterior mediastinal mass. You would suggest a. Medical management for myasthenia gravis b. Radiation therapy c. Excision of the mass ( thymoma) d. Thymectomy e. Surgery and adjuvant chemotherapy/radiotherapy

Items 37-40 a. Primary lung cancer b. Secondary lung cancer ( metastatic) c. Both d. Neither

Items 16-23 a. Surgery b. Chemotherapy c. Both d. Neither

VASCULAR SURGERY 41. An 80 year old male with a history of bleeding peptic ulcer and recent stroke is the ER complaining of severe pain of the left leg and foot. On examination, the extremity is cold with absent pulses. Treatment should consist of: a. Oral anticoagulant b. Embolectomy c. Systemic thrombolysis d. Heparinization

16. 17. 18. 19. 20. 21. 22. 23.

Stage III B non small cell lung CA Seminoma Mediastinal lymphoma Thymoma Chest wall osteosarcoma Chest wall chondroma Bronchial carcinoid SVC syndrome

B B B C

Bullous emphysema Empyema thoracis Lung abscess Bronchogenic cyst Massive hemoptysis

B

C C A D

C C C A D

29. Spontaneous pneumothorax with blebs 30. Moderate pleural effusion secondary to PTB B 31. Tension pneumothorax B 32. Empyema thoracis, trapped lung A 33. Giant lung abscess

42. Lower extremity arterial revascularization for chronic arterial occlusion is recommended for which of the ff conditions? a. Claudication b. Diabetic neuropathy c. Ischemic gangrene of leg and foot d. Resting foot pain 43. a. b. c. d.

A 72 y/o pulsatile abdominal mass aorta… Abdominal CT scan Aortography MRI Exploratory surgery

44. The most effective Buerger’s disease is: a. Diet b. Vasodilator therapy c. Surgery d. Abstinence from tobacco

Items 29-33 a. Tube thoracostomy b. Thoracotomy c. Both d. Neither A

A

Items 34-36 a. VATS b. open thoracotomy c. Both d. Neither 34. Unexplained one-sided pleural effusion 35. Thymoma 36. Mesothelioma A

Pleural effusion CT scan –guided needle biopsy Pneumonectomy Neoadjuvant radiation therapy

C A A

Items 24-28 a. Chest X-ray b. Chest CT scan c. Both d. Neither 24. 25. 26. 27. 28.

37. 38. 39. 40.

A C

treatment

modality

for

45. Proper management of a 86 y/o patient with asymptomatic 3cm intrarenal abdominal aortic aneurysm would consist of: a. Elective aneurysm repair b. Intervention only if symptoms develop c. Medication and limitation of activity d. Reassurance and observation 46. a. b. c. d. e.

Ischemic resting pain typically involves the Diet Thigh Calf Sole and hindfoot Forefoot and toes

47. The diagnosis of Buerger’s disease can be best made on the basis of a. History of arm and thigh claudication b. Young age, blood type a c. Gangrene of the fingers and toes d. Finding of inflammatory cells forming a large part of the occluding thrombus

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48. The most ominous sign of arterial occlusion is a. Ischemic ulceration b. Severe unrelenting pain c. Paralyzed anesthetic extremity d. Coldness and pallor

advanced

acute

49. Which of the following statement regarding lower extremity arterial disease is NOT TRUE? a. Ankle/ brachial index of 0.9 or lower is seen in normal individuals b. calcification of leg arteries in diabetes may result in abnormally high ankle/ brachial indeces c. arterial duplex scan is the initial diagnostic exam of choice d. segmental pressure measurements can define disease location in most instances 50. Which of the following statements most appropriately describes claudication? a. It is typically manifested a joint below the level of occlusion b. Diabetics rarely experience claudication mainly because of their neuropathy c. Claudication typically starts at the buttocks, down the thigh, calf and foot d. Claudication frequently progresses to gangrene of the lower extremity

Heparinization Ischemic/Necrosis Paralysis Amputation Vasodilator therapy

A C C A D

56. Pulmonary embolism greatest risk Iliofemoral thrombosis 57. Vena caval filter placement for Patient with DVT who had stroke 58. Primary varicose veins Valvular reflux 59. Pulmonary embolism Ventilation/Perfusion scan 60. Treatment for varicose vein EXCEPT: Chelation 61. At risk for DVT Hip replacement therapy 62. CV Except: Venous thrombosis 63. Source of LE arterial emboli Left atrium

65. Management of AOD EXCEPT: Vasodilator Items 66-70 Arterial vs. Venous a. Venous b. Arterial c. Both d. Neither 66. 67. 68. 69. 70.

Homocysteine LMW heparin Cigarette smoking Gangrene Warfarin

C A B C C

Items 71-75 CVI vs Primary varicose veins a. CVI b. Primary varicose veins c. Both d. Neither 71. 72. 73. 74. 75.

Valvular incompetence Stockings Thrombosis Venous ulcers Warfarin

C C C A D

Items 76-80 Buerger’s vs Artherosclerotic occlusive disease a. Buerger’s b. Artherosclerotic occlusive disease c. Both d. Neither

Items 51-55 a. Acute arterial occlusion b. Chronic arterial occlusion disease c. Both d. Neither 51. 52. 53. 54. 55.

Proximal lower extremity v.

76. 77. 78. 79. 80.

Inflammation Smoking Gangrene Upper extremity involvement DM

A C C C B

Items 81-85 Unfractioned vs LMW heparin a. LMW heparin b. Unfractioned heparin c. Both d. Neither 81. 82. 83. 84. 85.

Venous thrombosis Acute arterial occlusion Chronic arterial occlusion Protime/PTT Subcutaneous injection

A B D C C

Items 86-90 Arterial ulcer vs Neuropathic ulcer a. Arterial ulcer b. Neuropathic ulcer c. Both d. Neither 86. 87. 88. 89. 90.

DM Bleeding Painless Goiter area Delayed/poor healing

C B B D C

64. Mc source of clinically important PE

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